Popliteal artery aneurysm.

Fourteen patients with atherosclerotic aneurysms of the popliteal artery, which were bilateral in 13, have been managed in a vascular unit where ultrasound, xerography, and isotope angiography are available for investigation. Although these methods are useful in confirming a suspected diagnosis, they cannot replace an awareness of the condition and clinical methods of examining the ischaemic lower limb. Reconstructive vascular surgery was effective in preserving the presenting leg in 5 cases and amputation was needed in 6, while no operation was needed in 3. Elective arterial surgery was carried out on the asymptomatic contralateral leg in 7 cases with good results and this active approach to treatment is recommended.

Silicone rubber band treatment of rectal prolapse.

Fifty-two patients with rectal prolapse have been treated by the silicone rubber band perianal suture technique and satisfactory results have been obtained in 46 (89%). Eleven patients required reoperation to achieve this result. The procedure is a minor one, with little morbidity and no mortality. Provided that faecal impaction can be avoided in patients having this operation a successful outcome, can be expected. It is recommended especially for the frail and elderly with rectal prolapse.

Experimental bacterial infection of the biliary tract.

The bacterial species commonly found in the human obstructed biliary tract were studied in an animal model of acute hepato-cholangitis. A rank order of their virulence and persistence in the bile and liver was shown which corresponded well to the clinical effects in the animals and also to the prevalence of bile bacteria in the benign bile duct stricture of man. Anaerobic organisms were found to be of low pathogenicity.

Bile bacteria in patients with benign bile duct stricture.

In a prospective study of 73 patients undergoing hepatodochojejunostomy for benign bile duct stricture who were covered by antibacterial prophylaxis with gentamicin and cephalolothin, bacteria were cultured from bile sampled at operation in 80 per cent of cases. Aerobic organisms were found in 50 cases (82 per cent) and anaerobic organisms in 11 cases (18 per cent). Seventy-three per cent of the patients with postoperative septic complications had bile cultures positive for anaerobes at operation, and the same organisms were cultured from pus. All patients with anaerobes in the bile at some time in the perioperative period developed postoperative sepsis. Antibacterial prophylaxis with gentamicin and cephalothin, together with specific therapy with drugs effective against anaerobes when indicated, are recommended in the management of these cases.

Deep vein thrombosis after thoracotomy.

In a prospective study of 183 patients undergoing lateral thoracotomy the 125 I fibrinogen uptake test and perioperative heparin prophylaxis for deep-vein thrombosis were investigated. There was an incidence of deep vein thrombosis in 51% in untreated control patients. The heparin prophylaxis effectively reduced the incidence of deep venous thrombosis to 28% (P less than 0.005) without increasing postoperative blood loss. Unilateral thrombosis was found to be significantly more frequent in the leg opposite the side of the thoracotomy (P less than 0.005). The 125I fibrinogen test is essential in assessing methods of prophylaxis but is not recommended as a routine.

The hormone response to a synthetic androgen (mesterolone) in oligospermia.

Forty subfertile men with oligospermia were treated with a synthetic androgen (Mesterolone). The effect of the drug was evaluated by measuring serum testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and analysing the semen before and after treatment. The results demonstrated that in twenty-three patients treated for 6-9 months there was a significant decrease in serum testosterone (P less than 0.01); the means +/- SEM before and after treatment were 17.05 +/- 0.95 and 14.7 +/- 0.95 (nmol/l serum) respectively. There was a pronounced increase in serum LH (P less than 0.01), the values being 2.73 +/- 0.26 and 3.61 +/- 0.3 (u/l) respectively. However, no significant difference was found in serum FSH before and after treatment. The sperm concentration showed a variable response to treatment. In twenty-one patients there was either no change or worsening in the sperm concentration, whereas in nineteen patients an improvement was observed. The analysis of variance of sperm concentration and motility for the periods before and after treatment, for all the patients, showed no significant difference in the sperm concentration F1.145 = 2.82 (P=0.1).

Urinary infection and prostatectomy.

The incidence of urinary infection before and after operation for benign prostatic hypertrophy has been reviewed in 140 patients. Repeated screening for bacteriuria was used throughout the hospital admission. Infection was present in 24% before operation and there was a significant correlation between the incidence of infection and the duration of preoperative catheterisation. Postoperative infection developed in 31% and there was no relation between this incidence and the type of prostatectomy; specific antibacterial therapy was significantly more effective in eradicating urinary infection acquired after operation than before. At the time of discharge from the ward, 10% had infected urine, but only 3% of patients had persistent infection at follow-up 6 weeks after operation.

The dip-slide in urology.

To assess the value of the Uricult dip-slide in a hospital urological unit, bacteriological examination of 1,033 urine specimens was compared by this technique and by conventional methods. In 87% of cases identical results were obtained using the dip-slides and the standard laboratory culture plates. Insignificant differences occurred in 10%, and a serious discrepancy between the two methods was found in only 3%. The Uricult dip-slide technique is valuable as a bacteriological screening procedure in urological practice but subculturing from the slide is not recommended except in special circumstances.